As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.
Humans ; Consensus ; Critical Care/methods* ; Intensive Care Units ; Pain/drug therapy* ; Analgesics/therapeutic use* ; Delirium/therapy* ; Critical Illness

Objective: To analyze the pathological classification of malignant peritoneal mesothelioma (MPeM) and screen the immunohistochemical markers that can distinguish MPeM from peritoneal metastatic carcinoma (PC) . Methods: In June 2020, the pathological results of peritoneal biopsy of 158 MPeM and 138 PC patients from Cangzhou Central Hospital, Cangzhou People's Hospital, and Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2011 to July 2019 were retrospectively analyzed, and the pathological classifications of MPeM in Cangzhou were summarized. Immunohistochemical markers of MPeM and PC patients were analyzed, and receiver operating characteristic curve (ROC curve) was drawn for differential diagnosis of MPeM and PC. Results: There were 55 male and 103 female MPeM patients in Cangzhou, with an average age of 57.1 years old. The asbestos exposure rate was 91.14% (144/158). The most common pathological classifications were cutaneous type, accounting for 90.51% (143/158). There were significant differences in the expression of calreticulum protein, CK5/6, vimentin, D2-40, carcinoembryonic antigen (CEA) and tail type homologous nuclear gene transcription factor 2 (CDX-2) between MPeM and PC (P<0.05). Among the 6 positive markers, the sensitivity of calreticulum protein was the highest (0.905) and CEA was the lowest (0.428) . Conclusion: Calreticulum protein, CK5/6, vimentin, D2-40, CEA and CDX-2 may be used as specific markers to distinguish the diagnosis of MPeM from PC.

Objective: To investigate the distribution of HIV-1 genetic subtypes and pretreatment drug resistance (PDR) among men who have sex with men (MSM) from 19 cities of 6 provinces in China. Methods: From April to November 2019, 574 plasma samples of ART-naive HIV-1 infected MSM were collected from 19 cities in Hebei, Shandong, Jiangsu, Zhejiang, Fujian, and Guangdong provinces, total ribonucleic acid (RNA) was extracted and amplified the HIV-1 pol gene region by nested polymerase chain reaction (PCR) after reverse transcription. Then sequences were used to construct a phylogenetic tree to determine genetic subtypes and submitted to the Stanford drug resistance database for drug resistance analysis. Results: A total of 479 samples were successfully amplified by PCR. The HIV-1 genetic subtypes included CRF01_AE, CRF07_BC, B, CRF55_01B, CRF59_01B, CRF65_cpx, CRF103_01B, CRF67_01B, CRF68_01B and unrecognized subtype, which accounted for 43.4%, 36.3%, 6.3%, 5.9%, 0.8%, 0.8%, 0.4%, 0.4%, 0.2% and 5.5%, respectively. The distribution of genetic subtypes among provinces is statistically different (χ²=44.141, P<0.001). The overall PDR rate was 4.6% (22/479), the drug resistance rate of non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors were 3.5% (17/479), 0.8% (4/479) and 0.2% (1/479), respectively. The PDR rate of recent infections was significantly higher than that of long-term infections (χ²=4.634, P=0.031). Conclusions: The HIV-1 genetic subtypes among MSM infected with HIV-1 from 19 cities of 6 provinces in China are diverse, and the distribution of subtypes is different among provinces. The overall PDR rate is low, while the PDR rate of recent infections was significantly higher than that of long-term infections, suggesting the surveillance of PDR in recent infections should be strengthened.
China/epidemiology* ; Cities ; Drug Resistance ; Drug Resistance, Viral/genetics* ; Female ; Genotype ; HIV Infections/epidemiology* ; HIV Seropositivity/drug therapy* ; HIV-1/genetics* ; Homosexuality, Male ; Humans ; Male ; Phylogeny ; Reverse Transcriptase Inhibitors/therapeutic use* ; Sexual and Gender Minorities

Hd-Zip, a unique transcription factor in plant kingdom, influences the growth, development, and secondary metabolism of plants. Hd-zip Ⅳ is thought to play an important role in trichome development of Schizonepeta tenuifolia. This study aims to explore the functions of StHD1 and StHD8 in Hd-zip Ⅳ subfamily in peltate glandular trichome development. To be specific, the expression patterns of the two genes and interaction between the proteins encoded by them were analyzed based on transcriptome sequencing and two-hybrid screening. The subcellular localization was performed and functions of the genes were verified in tobacco and S. tenuifolia. The results showed that StHD1 and StHD8 had high similarity to HD-Zip Ⅳ proteins of other plants and they all had the characteristic conserved domains of HD-Zip Ⅳ subfamily. They were located in the nucleus. The two genes mainly expressed in young tissues and spikes, and StHD1 and StHD8 proteins interacted with each other. The density and length of glandular trichomes increased significantly in tobacco plants with the overexpression of StHD1 and StHD8. Inhibiting the expression of StHD1 and StHD8 by VIGS(virus-induced gene silencing) in S. tenuifolia resulted in the reduction in the density of peltate glandular trichomes, the expression of key genes related to mono-terpene synthesis, and the relative content of limonene and pulegone, the main components of monoterpene. These results suggested that StHD1 and StHD8 of S. tenuifolia formed a complex to regulate glandular trichomes and affect the biosynthesis of monoterpenes.
Trichomes/metabolism* ; Lamiaceae/genetics* ; Tobacco/genetics* ; Monoterpenes/metabolism* ; Cloning, Molecular ; Plant Proteins/metabolism* ; Gene Expression Regulation, Plant

OBJECTIVETo investigate the molecular mechanism by which salidroside protects PC12 cells from HO-induced apoptosis.

METHODSPC12 cells cultured in DMEM supplemented with 10% horse serum and 5% fetal bovine serum were pretreated with different doses of salidroside for 2 h and then stimulated with HOfor different lengths of time. The expression levels of PARP and caspase 3 and the phosphorylation of p38, ERK and JNK were determined with Western blotting. The cell nuclear morphology was observed after DAPI staining. The production of ROS was detected using a ROS detection kit, and the levels of gp91and p47in the membrane and cytoplasm were detected by membrane-cytoplasm separation experiment; the binding between gp91and p47was assayed by coimmunoprecipitation experiment.

RESULTSSalidroside dose-dependently suppressed cell apoptosis, lowered phosphorylation levels of p38, ERK and JNK, inhibited the production of ROS, reduced the binding between gp91and p47, and inhibited the activity of NOX2 in PC12 cells exposed to HO.

CONCLUSIONSalidroside protects PC12 cells from HO-induced apoptosis at least partly by suppressing NOX2-ROS-MAPKs signaling pathway.

Animals ; Apoptosis ; Caspase 3 ; metabolism ; Glucosides ; pharmacology ; Hydrogen Peroxide ; MAP Kinase Signaling System ; drug effects ; Membrane Glycoproteins ; metabolism ; NADPH Oxidase 2 ; NADPH Oxidases ; metabolism ; Neuroprotective Agents ; pharmacology ; PC12 Cells ; Phenols ; pharmacology ; Phosphorylation ; Rats ; Reactive Oxygen Species ; metabolism

OBJECTIVETo determine whether non-targeted testing strategy (screening all patients with blood sample withdrawn) could identify more patients with newly diagnosed HIV infection than symptom and risk behavior based targeted testing strategy or not.

METHODSControlled trial design was applied in this study.From July to November 2011, outpatient department of L and J county hospital in Guangxi province were selected to conduct the targeted strategy and non-targeted strategy respectively. The two counties had similar population, outpatient volume, previous testing rate and number of newly identified HIV cases.Outpatients older than 15 years were recruited as study subjects, with 62 106 person time in L hospital and 58 257 in J hospital. Data about visit number, persons receiving HIV testing and HIV positive cases were collected by outpatient department. Chi-square test was used to compare the percentage of newly identified HIV cases, HIV positive detection rate and proportion of cases in early AIDS phase between two strategies.

RESULTSDuring the study period, 9.69% (5627/58 057) of all outpatients in J hospital with non-targeted strategy and 1.38% (859/62 106) of all outpatients in L hospital with targeted strategy received HIV test. The average age of patients receiving HIV testing was 46.23 ± 16.81 and 40.75 ± 15.48 respectively, which was statistically different (t = 8.81, P < 0.05). The percentage of newly identified HIV cases was significantly greater in J hospital (0.03% (19/58 057)) than that in L hospital (0.02% (10/62106)) (P < 0.05) while the HIV positive detection rate was lower in J hospital (0.34% (19/5627)) than that in L hospital (1.16% (10/859)) (χ(2) = 9.66, P < 0.05).

CONCLUSIONIn a concentrated epidemic, a hospital based non-targeted strategy could detect more unidentified HIV cases than targeted strategy.

Acquired Immunodeficiency Syndrome ; diagnosis ; Adult ; Ambulatory Care Facilities ; Female ; HIV Infections ; diagnosis ; Humans ; Male ; Mass Screening ; Middle Aged ; Outpatients

OBJECTIVETo evaluate the effect of Xuezhikang (XZK) on cardiac function and serum C-reactive protein (CRP) in patients with chronic heart failure (CHF).

METHODSSixty-eight CHF patients were randomly assigned to two groups, the control group (30 cases) treated with angiotensin converting enzyme inhibitor, beta-receptor inhibitor, digoxin and diuretic, and the treated group (38 cases) with the above treatment plus XZK for six months. The changes of cardiac function and serum CRP level were measured by echocardiography and enzyme-linked immunosorbent assay (ELISA) respectively before and after treatment.

RESULTSCompared with those before treatment, the NYHA cardiac function grade, the left ventricular dimension end diastole (LVDd), and the left ventricular dimension end systole (LVDs) decreased significantly (P < 0.05), and the ejection fraction (EF) and E/A ratio increased significantly in both groups after treatment (P < 0.05) , however, the decrement or increment was more significant in the treated group than that in the control group respectively (P < 0.05); the serum CRP level decreased significantly in the treated group after treatment and showed a level obviously lower than that in the control group (P < 0.05), which changed insignificantly after treatment.

CONCLUSIONXuezhikang could improve cardiac function and decrease serum CRP level at the same time.

Adrenergic beta-Antagonists ; therapeutic use ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; C-Reactive Protein ; metabolism ; Cholesterol ; blood ; Digoxin ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Failure ; blood ; drug therapy ; physiopathology ; Humans ; Lipoproteins ; blood ; Male ; Middle Aged ; Phytotherapy ; Ventricular Function, Left ; drug effects

OBJECTIVETo quantify neuroanatomical parameters with magnetic resonance imaging (MRI) and to explore the relationship between these parameters and age.

METHODSTotally 150 adults aged 18-83 years received 3D fast spoiled gradient echo imaging. Volume of intracranial space, whole brain, gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were measured and normalized.

RESULTSNormative volumetric estimates were obtained for all subjects and presented by age and sex. There was not significantly age-related change in intracranial space volume. Whole brain volume did not significantly change before 30 years, thereafter, decline with age. SM volume decreased linearly with age. CSF volume increased linearly with age. WM volume and GM/WM ratio demonstrated a quadragnetic pattern of change with age. WM volume increased slightly in subjects until the age of 45 years, and it decreased thereafter. However, GM/ WM ratio decreased quickly in subjects until the age of 55 years, and it decreased slightly thereafter. Although the volumes of intracranial space and whole brain had significant differences between male and female (P < 0.05), the volumes of whole brain, GM, and CSF had no significant differences after normalization.

CONCLUSIONIn vivo MRI can measure the normal patterns of age- and sex-related changes in intracranial space, whole brain, GM, WM, and CSF, and may facilitate the appraisal of abnormal brain volumes. Keased linearly words: brain;ge. WM vol urement; magnetic resonance imaging

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Brain ; anatomy & histology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sex Factors

OBJECTIVETo investigate the association between serum cardiac troponin I (cTnI) and cardiac function/structure in patients with chronic heart failure.

METHODSOne hundred and twenty patients with decompensated chronic heart failure were included. The patients were divided into cTnI normal group (cTnIn; n = 80) and cTnI elevated group (cTnIe; n = 40). Systolic dimension of the left atrium (LAd), the maximal width of the left ventricle (LVd), the thickness of the interventricular septum (IVS) and posterior wall (LVPW) during diastole, left ventricle ejection fraction (LVEF), E and A wave velocities ratio (E/A) were determined. Bivariate correlation analysis was applied to show the correlation of serum cTnI level with above indices. Partial correlation analysis was performed followed by multivariate logistic regression.

RESULTSLAd and LVd dimensions were significantly higher (P < 0.05), IVS, LVPW, LVEF and E/A ratio were significantly lower (P < 0.05) in cTnIe group than in cTnIn group. Moreover, serum cTnI was positively correlated with LAd, LVd, and inversely correlated with IVS, LVPW, LVEF and E/A ratio (P < 0.05). The correlation persistent after adjusting with sex, history of heart failure, NYHA functional class and treatment. In multivariate modeling, cTnI was positively associated with LAd, LVd and the history of heart failure, and negatively related with the treatment with angiotensin-converting enzyme inhibitor.

CONCLUSIONSerum cTnI correlated with cardiac structure and function. Intensively serum cTnI monitoring and suitable therapy strategy may be helpful to attenuate the cardiac remodeling in patients with chronic heart failure.

Adult ; Chronic Disease ; Female ; Heart Failure ; blood ; physiopathology ; Humans ; Male ; Middle Aged ; Myocardium ; chemistry ; Troponin I ; blood ; Ventricular Remodeling